Provider Demographics
NPI:1881908812
Name:MONARC INCORPORATED
Entity type:Organization
Organization Name:MONARC INCORPORATED
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:MR
Authorized Official - First Name:MARK
Authorized Official - Middle Name:N
Authorized Official - Last Name:SAMONTE
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:310-720-1832
Mailing Address - Street 1:23049 ARCHIBALD AVE
Mailing Address - Street 2:
Mailing Address - City:CARSON
Mailing Address - State:CA
Mailing Address - Zip Code:90745-4718
Mailing Address - Country:US
Mailing Address - Phone:310-720-1832
Mailing Address - Fax:323-785-1282
Practice Address - Street 1:21414 S VERMONT AVE
Practice Address - Street 2:C/O HERITAGE REHABILATION CENTER
Practice Address - City:TORRANCE
Practice Address - State:CA
Practice Address - Zip Code:90502-1935
Practice Address - Country:US
Practice Address - Phone:310-720-1832
Practice Address - Fax:323-785-1232
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2010-08-02
Last Update Date:2010-08-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAA98537261Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261Q00000XAmbulatory Health Care FacilitiesClinic/Center
Provider Identifiers
StateIdentifier IDID TypeIssuer
CAAP401YMedicare PIN
CAWA98537AMedicare PIN